La Clínica de La Raza is a nonprofit Federally Qualified Health Center with 49 years of experience providing comprehensive, culturally competent clinical and community health services. The mission of La Clínica is to improve the quality of life of the diverse communities it serves by providing culturally appropriate, high-quality accessible healthcare for all.
Originally staffed by five volunteers in a storefront clinic, La Clínica has grown to become one of the largest community health centers in California, with 35 service sites across Alameda, Contra Costa and Solano Counties.
La Clínica served approximately 90,000 patients in 2019, with comprehensive services including pediatrics, family medicine, women’s healthcare, behavioral health, dental, vision and health education. Services are offered regardless of patients’ ability to pay or insurance coverage.
Because of the surging COVID-19 pandemic, California issued a shelter-in-place order effective March 16, 2020, just six weeks before La Clínica’s scheduled Epic’s go-live on April 28, 2020, when La Clínica was slated to transition from the NextGen EHR to the Epic EHR via OCHIN, a nonprofit health IT services provider.
“As early as January, La Clínica had in place a robust training program, as well as a fully fettered out support plan for go-live,” said Fernando Cortez, CIO and information security officer at La Clínica. “When the shelter-in-place order was given, three work streams were converging: how to train remaining staff, how to approach go-live activities, and how to keep our staff and patients safe, before, during and after the EHR system transition.”
Leadership from all La Clínica operational departments – medical, dental and behavioral health – along with administration, fiscal and IT departments, all worked together with OCHIN leadership in order to quickly strategize a plan and immediately move to implement it, with significant project management support from Pivot Point Consulting.
“OCHIN provided the option to postpone the go-live to later in the spring or fall of 2020,” Cortez said. “However, no one could predict the best reschedule date for a ‘normal’ go-live, and consideration was given for additional costs, rescheduling of time-sensitive project components such as interface cut-over dates, and possibly refreshing training for many staff.”
After careful deliberation, leadership determined that La Clínica would move forward with the previously scheduled go-live date at the end of April 2020, and OCHIN agreed to support that decision. There was no proven methodology for virtual training or a virtual go-live, so La Clínica and its partners sat down to create training and go-live plans with new objectives.
“Prior to the shelter-in-place order, most of La Clínica’s super-users had been trained, but the bulk of 1,150 staff required scheduled in-person training,” Cortez explained. “To complete this training after the shelter-in-place order across three California Bay Area counties (Alameda, Contra Costa and Solano), spanning approximately 50 miles, multiple learning labs and training rooms, which previously were set up for training, were reconfigured to meet social distance requirements, and plans were implemented to allow staff to take training from home.”
In the early months of the project, well before the shelter-in-place order, it had taken more than three months to carefully orchestrate a training plan. La Clínica knew that quickly developing a new model, post shelter-in-place, would be a heavy lift. La Clínica’s EHR training team identified and worked through the intricacies of this plan.
The challenge became to revisit and develop priorities in the new situation and find the most effective and efficient path to achieve them with the technology available. La Clínica leadership and project teams, OCHIN, and Pivot Point Consulting project manager Margaret Moore collaborated on options for virtual training and a virtual go-live model that met the new requirements and objectives.
“La Clínica looked carefully at which tools already were technically in-hand,” Cortez noted. “For example, La Clínica had a new, but not yet implemented, help desk system that had an inventory system embedded. La Clínica could use that inventory system for tracking and supporting devices remotely. OCHIN had a robust virtual training system with Zoom that required some reconfiguration, but that could be used to replace in-person training, as well as help to provide at-the-elbow go-live support.”
Using remote support options, such as tools from LogMeIn, La Clínica worked directly with employees who were working from home to assist them through preparing their personal computers for remote training and virtual go-live. Increasing bandwidth throughout La Clínica was a priority, and included implementing new and faster business-class Internet connectivity. The solution was multifaceted and required a tight, multidisciplinary team approach to overcome barriers, Cortez said.
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MEETING THE CHALLENGE
La Clínica paused all project work for one week to develop multiple plans, address mitigation for risks, and put a support model in place for ongoing clinical work. This directly impacted training that would now be a week behind. During this time, La Clínica and the Pivot Point Consulting project manager did an extensive risk review for any needed mitigation measure and looked at what would need to be accepted and monitored.
“La Clínica used virtual meetings and assigned IT staff to be immediately available to set up personal devices, with a high concern for security for clinical staff,” Cortez explained. “Employees with La Clínica laptops already had appropriate equipment and credentials to connect to the network. This work would support the training that many would need to do or complete and later would enable staff participation in virtual go-live activities. La Clínica increased its network monitoring … from a security perspective, but as well to assure quick response for staff having technical difficulties working remotely.”
Training was revamped with OCHIN. The virtual meeting platform was expanded so all the classes previously scheduled in-person could be done virtually. Schedules and regular, often daily, communication were resumed. Learning labs were available, but only with very limited staff using them at the same time because of social distancing requirements.
After the virtual training was completed through approximately the first two weeks, La Clínica and OCHIN determined a smaller virtual class size allowed for more of the needed interaction to improve the quality of the education. More classes were scheduled, and helped to accommodate the work-from-home needs of staff struggling to balance a new family lifestyle of working from home at the same time their children were in virtual school, oftentimes using the same family laptop or PC.
“Experience has proven that at-the-elbow support during go-live is critical,” Cortez stated. “Over 80 OCHIN consultants and others were scheduled to support La Clínica’s original go-live model. The success factors that La Clínica identified were the need for immediate assistance, at-the-elbow, and providing for ongoing and immediate communication flow.”
For the at-the-elbow support feel, OCHIN provided separate, ongoing Zoom virtual meetings with the capacity for breakout rooms. These breakout rooms were constructed by county and by department. In all, approximately 14 meetings were set up in this virtual model, and more could be added if needed.
La Clínica’s IT department also used virtual meetings to assist with device support, printing and any other technical issue that came up. La Clínica site specialists and workflow SMEs were available within their meetings and super-users were each given their own virtual meeting to ensure they could keep the recommended social distance in crowded clinics.
More than 250 temporary licenses were purchased for use by super-users during this period. As well, Microsoft Teams was used to disseminate information and gather questions at the staff level. It was efficient and effective and helped to provide an ongoing record, Cortez said.
“The virtual command center was facilitated by La Clínica staff and the Pivot Point Consulting project manager,” Cortez explained. “It provided the same functionality as a physical command center. It was the hub of communication and kept a status on all aspects of the EHR go-live implementation.”
Leadership could call in to any of the virtual meetings to see what kinds of questions were being asked. Staff could call in to the command center with questions or needed guidance. Debriefs were held with command center virtual meetings. A command center schedule with support staff was published weekly. Despite the pandemic, the command center closed at the end of the third week, having met all of La Clínica’s metrics.
“The most important guiding principle was to keep our staff and patients safe,” Cortez said. “Virtual meetings – GoToMeeting and OCHIN’s Zoom platform – were used to accomplish that priceless end. More than 60% of our staff needed to be trained virtually when we needed to restructure our approach. In less than six weeks, more than 650 clinicians were trained [and] practiced, and felt confident in the system, due to the creativity, careful planning and determination of La Clínica and its partners to provide quality materials and training sessions.”
Of course, travel time to physical classrooms was tremendously reduced, both for staff and OCHIN trainers not needing to be physically on site. OCHIN aligned approximately 80 contractors for the first week, and La Clínica engaged an additional three to five in three subsequent weeks for post-go-live support.
Eliminating travel for training and go-live support saved La Clínica approximately $200,000.
ADVICE FOR OTHERS
“For any project, it is important to identify success factors, guiding principles and business cases,” Cortez advised. “However, these may look a little different with the use of virtual models. Inventory what technology you have and what your partners can provide. Identify your limitations and/or gaps. Then work with your partners to fill those or find creative ways to work around them effectively and efficiently.”
Build a strong multidisciplinary team. Multidisciplinary is key. And do not forget all levels of staff, including frontline staff, he added.
“Often, frontline staff know exactly what is needed,” he said. “Utilize strong and proven project managers who can navigate the myriad of issues and wield effective project management tools for success. Tightly coordinate senior leadership and trust their input and recommendations. No one person can know it all. It will take a well-coordinated team to achieve success.”
Inform patients early of the project and keep them informed, he said.
“Always include your CEO, and look to them for direction-setting, advice and their all-important tie-breaking ability,” Cortez concluded. “Finally, constantly recognize all levels of the organization. T-shirts, lanyards, mugs and food go a long way. And so do the simple words, ‘Thank you, I appreciate what you have done.’”
Email the writer: [email protected]
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